ORIGINS AND OBJECTIVES
Breast cancer: second leading cause of death among women in the world
After cardiovascular diseases, cancers constitute the second cause of death among women in the world, being responsible for 14% of death worldwide in 2012. Breast cancer is the most common cause of cancer death among women. The number of women concerned by cancer could dramatically increase by 2030. In 2012, two reports from American Cancer Society and The Lancet warned of an increase in cancer deaths among women, with a toll, mainly from breast cancer, of around 5.5 million a year by 2030 – this would represent a near 60% increase in less than two decades (3.5 million).
Hundreds of thousands of lives could be saved from cancer (lung, cervical, colorectal and breast) by improving the fight against smoking, fostering better nutrition and vaccination, and above all developing treatment and early screening. ACS report highlights the main vulnerabilities within poorer countries where access to diagnosis and treatment concern a very small proportion of cancer cases. Massive investment in favor of education, healthcare and prevention are required to stem the spread of the disease. Women in these countries are increasingly exposed to known cancer risk factors “associated with rapid economic transition”, said Sally Cowal , “such as physical inactivity, unhealthy diet, obesity, and reproductive factors” including postponing motherhood. Control of specific modifiable breast cancer risk factors (diet, physical activity, alcohol intake) could therefore reduce the impact of breast cancer in the long term, but ‘early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control’ according to the WHO.
“An urgent need in cancer control today is to develop effective and affordable approaches to the early detection, diagnosis, and treatment of breast cancer among women living in less developed countries” Dr Christopher Wild, Director of the IARC, says .
In France, 54,000 new cases were diagnosed during the year. However, when it is detected early, breast cancer is associated with good survival rates: on average 9 in 10 breast cancers are cured if treated early enough. Still, among the most exposed population (50-74 years-old women), 50% of French women choose not to participate in organized breast cancer screening program which propose a free mammography exam and one third of them is neither followed regularly by a gynecologist. Early screening and prevention are major axes of breast cancer’s mortality reduction.
Genesis of the project
Isabelle Fromantin joined the Curie Institute in 1993 where she worked as a nurse in pediatrics and ENT surgery before participating in the creation of the first mobile unit of Palliative Care in a Center for the Fight against Cancer in 1997. She is now a researcher associated with the Nursing Sciences Research Chair of the University Paris 13, Vice-President of the French and Francophone Society of Wounds and Healing until 2017 and member of several Scientific Committees.
The hypothesis: Volatile Organic Compounds as biomarkers for breast cancer
In 2009 Isabelle Fromantin starts a thesis about wounds and lesions caused by breast cancer. She focused her research more specifically on odors associated with malignant wounds. Indeed the human body naturally produces organic chemicals called Volatile Organic Compounds (VOCs). Malignant wounds also emit VOCs. Dr Fromantin thus came to one particular question: would it be possible to establish a link between the presence of particular odors (VOCs) and the presence of cancer cells?
“Volatile organic compounds are biomarkers produced by cancer cells. When going deeper into the study, the idea of an olfactory detection of breast cancer quickly became a main axis of my research” Dr Fromantin explains. Other researches in the scientific literature support this hypothesis that VOCs form biomarkers of cancer.
Therefore, being able to identify this specific olfactory signature would constitute an effective way to detect the presence of cancer. Why not then taking advantage of this correlation to develop transcutaneous sensors for cancer screening? But how could we identify and recognize an odor that is completely undetectable by human nose?
To analyze the scent emitted by malignant wounds, Isabelle Fromantin used two methods: analytical chemistry and canine olfactory detection. After comparison, the dog’s sense of smell seemed more acute and efficient than chemistry. Consequently, what if a dog was specially trained for cancer detection and put at work to find out cancer VOCs?
A multidisciplinary team
The meeting with a dog expert in 2011 gave its first impulsion to the KDOG project. A multidisciplinary team quickly constituted itself within the Curie Institute together with French engineering school ESPCI Paris. In 2015 caregivers from the Curie Institute (pathologists, nurses, cancer surgeons, anesthetists), scientific researchers in biology and chemistry (from ESPCI and Chimie Paris Tech) and dog experts (veterinarians, ethologists and dog-handlers) gathered to elaborate the research and place the olfactory sensibility of dogs at the service of medical progress.